Wirkung und Nebenwirkungen von Ibuprofen

Zusammenfassung

Ibuprofen ist ein weit verbreitetes nichtsteroidales Antiphlogistikum (NSAID). Es hemmt durch Blockade des aktiven Zentrums die Cyclooxygenase 1 und 2 (COX-1 und COX-2) reversibel. In höheren Konzentrationen als die zur Hemmung der COX-1 und COX-2 notwendig sind, zeigt es Antitumor-Aktivität. In OTC-Dosierung (over the counter) (<1200 mg/d) ist das Risiko zur Entstehung von gastrointestinalen Blutungen geringer als bei Diclofenac, Naproxen, Piroxicam oder Indomethacin. Mit Erhöhung der Dosis (2400–3200 mg/d) und Verlängerung der Therapiedauer steigt das Risiko für gastrointestinale Nebenwirkungen. Bei höheren Dosierungen und schon eingeschränkter Nierenfunktion kann Ibuprofen zu einem akuten Nierenversagen führen. Eine Kontrolle der Nierenfunktion ist in diesen Fällen angezeigt. Bei Kindern bis zu 12 Jahren, bei Schwangeren und auch älteren Patienten sollte Paracetamol der Vorzug gegeben werden. Patienten mit Hypertonie, welche mit ACE-Hemmern, Angiotensin-II-Rezeptorenblockern oder Thiazid-Diuretika behandelt werden, sollten Ibuprofen nicht über einen längeren Zeitraum einnehmen. Bei gleichzeitiger Einnahme von Ibuprofen und Acetylsalicylsäure wird die irreversible Hemmung von ASS auf die COX-1 vermindert, da Ibuprofen eine höhere Affinität zum aktiven Zentrum der COX-1 besitzt.

Eine kurzzeitige Behandlung mit Ibuprofen ist meist unproblematisch. Bei längerfristiger Therapie und höherer Dosierung muss zwischen niedrigem und hohem gastrointestinalem und kardiovaskulärem Risiko differenziert werden.

Abstract

Ibuprofen is a commonly used non-steroidal anti-inflammatory drug (NSAID). It inhibits the active center of cyclooxygenase 1 and 2 (COX-1 and COX-2) reversibly. In a concentration higher than for the inhibition of COX-1 and COX-2, ibuprofen inhibits tumorigenesis. In the ”over the counter dosage (<1200 mg/d)”, the risk for gastrointestinal bleeding is lower than for diclofenac, naproxen, piroxicam or indomethacin. However, with increasing dosage (2400–3200 mg/d) over a longer period of time, more gastrointestinal complications can occur. It is possible to induce an acute renal failure in patients with a limited renal function. In these cases, an observation of the renal function is recommended. For children up to an age of 12 years, pregnant women and elderly patients the NSAID of choice should be paracetamol. In combination with ACEIs (angiotensinogen converting enzyme inhibitors), ARBs (angiotensin receptor blockers) and thiazide diuretics, medication that is commonly used for the treatment of hypertension, chronic use of ibuprofen should be avoided. A simultaneous intake of ibuprofen and acetylsalicylic acid can reduce the irreversible inhibition of COX-1 by acetylsalicylic acid since ibuprofen has a higher affinity to the active center of COX-1.

Taken together, a short time ibuprofen treatment usually does not cause any problems. A therapy with ibuprofen over a longer period of time and in a higher dosage should be considered a high gastrointestinal or cardiovascular risk for the patient.

Schlüsselwörter

Ibuprofen - Wirkmechansimus - OTC-Dosierung - UAW des Ibuprofen - Interaktionen - Gastrointestinales Risiko - Cardivaskuläres Risiko

Key words

ibuprofen - mechanism of action - OTC-dosage - side effects - interactions - gastrointestinal risk - cardiovascular risk

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